Employee Benefits Blog

As has been widely reported, the Supreme Court has overturned the 1973 decision Roe v. Wade. In Dobbs v. Jackson Women’s Health Organization, the Supreme Court concluded there is no directly embedded Constitutional right to an abortion. Instead, the Court ruled that individual states can now regulate abortion.

So what will this mean for medical plan sponsors?

STATE REGULATION

Some states have already passed laws restricting abortion, while others have enacted “trigger laws” that ban or restrict abortion when Roe is overturned. (Laws regarding abortion vary by state and a complete rundown of these laws is beyond the scope of this initial write-up.) Additionally, it is likely that further legislative changes at the state level will be made in response to this decision, so this is a highly fluid situation.

That said, the immediate impact for a state like Arizona can be summed up in one word - uncertainty. Experts predict an immediate challenge to Arizona's anti-abortion laws as well as a fight to determine which of two anti-abortion laws will take precedence. One law was written 158 years ago while one is practically brand new.

The old law, created in Arizona’s territorial days, is a strict ban on providing or helping to provide an abortion, except to save the mother's life. It calls for a mandatory prison sentence of two to five years for violators.

Republicans in the state Legislature passed the new anti-abortion law this year; Gov. Doug Ducey signed it into law in March. Scheduled to take effect 90 days after the Legislature adjourns its current session (which may happen by the end of June), it bans abortions after 15 weeks of pregnancy except if necessary to save the mother’s life. Violating physicians face potential felony charges and loss of their professional licenses.

The state court system, likely the Arizona Supreme Court, will need to settle the issue as women seeking abortions and abortion service providers wait for guidance. Since this question remains unanswered, Planned Parenthood of Arizona has paused all abortions, both medical and surgical, and seven of nine licensed providers in the state have immediately halted abortions.

FEDERAL REGULATION OF HEALTH PLANS

Notably, in the employee benefits context this decision indirectly affects group health plans, especially insured plans issued in states that ban or limit abortion. Self-insured plans are also impacted, because though exempted from complying with state-mandated health care services, they must comply with state laws whenever reimbursing medical expenses incurred by plan participants.

Shown below is a list of key issues employers should consider in response to this decision. Note, however, that just as state laws are likely to be enacted in response to this decision, new federal rules may be introduced to modify the treatment of certain healthcare services, which would impact some of the considerations noted below.

If you’re an employer who has not yet made public your in-network negotiated rates, out-of-network billed charges, and historically allowed amounts, you have less than two weeks to complete this task.

This rule came into being through a series of overlapping transparency rules passed by congress in 2020 and 2021. Some were a part of a rulemaking from 2020 (the “Transparency in Coverage Rules” or “TiC Rules”), while others were enacted as part of the Consolidated Appropriations Act, 2021 (the year-end 2020 COVID relief bill or the “CAA”)).

Most fully-funded employers are conforming to this rule by simply ensuring that their carrier partners are making this information publicly accessible. Other employers, especially those who are self-funded, are conforming to this rule by accessing and posting links on their websites, which are being provided by insurance carriers or third-party administrators (TPAs) who are hosting these rates and historical payments on their own websites. Still, other employers are publishing this information directly on their own websites. 

That said, employers and group health plans must familiarize themselves with this disclosure requirement as insurance carriers and TPAs expect group health plan sponsors to assist them with posting the machine-readable files.

Here’s a recap of what the Transparency Rules entail;

The growing complexities of managing employee leave programs have led many employers to consider outsourcing their workforce absence management programs.
 
As we discussed in our last blog and on-demand webinar “Designing a Compliant PTO Program”, the pace of change in this area of employee benefits is somewhat unprecedented, due mostly, though not entirely, to growing legal requirements set forth at state and local levels.
 
A successful absent management program assists your employees with taking the time away from work when needed, as well as returning them to productive and contributing members of your organization. Elements of an absence management program include FMLA, short and long-term disability, paid time off, worker’s compensation, as well as other paid/unpaid leave programs, such as paid parental, sabbaticals, or other personal time.
 
To better prepare employers for this growingly complex area of employee benefits, we’ve put together this second webinar, which should help employers determine whether insourcing or outsourcing is the best strategy for their organization.

Designing a compliant Paid Time Off (PTO) program is a delicate balance between meeting the evolving needs of your employees and the growing legal requirements set forth at state and local levels.

Case in point - mandatory paid sick leave. Laws requiring paid sick leave have grown exponentially during the past eight years. And because paid sick leave laws are based on where an employee works, not on where they get their work assignments, multi-site employers and those with remote workforces are having a challenging time getting their arms around all of this.

To better prepare employers in this quickly evolving sector of employee benefits, we’ve put together this webinar, one of two thus far in our workforce absence management series.

This particular webinar is divided into three sections. The first section addresses the exponential growth of paid sick leave across the United States, while the second section discusses what’s currently being offered in the marketplace. The third and final section lays out options for keeping your paid time off program in compliance. You can watch this on-demand webinar simply by clicking here.

To learn more about workforce absence management and leave administration, contact us.

Since its inception, the Affordable Care Act (“ACA”) has measured “affordability” based solely on the cost of employee-only coverage.  This so-called “family glitch” has meant that spouses and dependent children of employees who are offered affordable, minimum value coverage have not been eligible for federal tax credits (Premium Tax Credits; “PTCs”) to purchase coverage through the marketplace.  

As a result, even though such family members might not receive a penny of employer-subsidized health coverage, an employer’s satisfying mandate duties to the employee has always been “imputed” to children and spouses, thereby effectively blocking those family members from obtaining any federal money.

Recently the Internal Revenue Service (“IRS”) announced proposed regulations that would change this. This IRS change solely alters family access to federal marketplace coverage subsidy funding but does NOT expand the employer mandate to include family coverage.

Historically speaking, retirees have typically relied on three primary tools to help them prepare for retirement: pension plans, Social Security, and defined contribution plans, like 401(k) plans.

That’s no longer the case. Pension plans are virtually non-existent, falling from nearly half of private sector participation in the mid-1980s to less than 15% today.   

As for Social Security, while it still provides the vast majority (90%) of income for nearly a quarter of retirees, the trust fund is facing a historic deficit, and without intervention, it will be depleted by the mid-2030s. 

LAWMAKERS ARE STEPPING IN

Faced with these obstacles, lawmakers are turning their attention to 401(k) plans, which are available to 68% of private industry workers, yet only 50% utilize them.

This is welcome news. By the end of this decade, the percentage of the U.S. population 65 or older will increase 40%, from 15% to 21%, according to the Census Bureau. Most concerning - nearly two-thirds of adults think they aren’t saving enough for retirement. 

A new bill, expected to reach President Joe Biden's desk by the end of the year, could usher in wide-sweeping changes to 401(k) plans. It could include auto-enrolling workers, escalating contributions over time, increasing contribution limits, integrating student loan repayments, delaying mandatory withdrawals, allowing part-time employee participation, and lowing costs for small businesses. 

Individual Coverage Health Reimbursement Arrangements (ICHRAs) are a new type of health reimbursement arrangement in which employers of any size can reimburse employees for some or all of the premiums that the employees pay for health insurance.

Employers can reimburse employees tax-free for individual health insurance, including coverage purchased on federal or state-sponsored health insurance exchanges, the individual markets, or Medicare.

And under federal rule changes in 2019, ICHRAs can be structured to fulfill the employer mandate under the ACA that requires most organizations to offer “affordable coverage" for employees.

Several high-profile people have tested positive for COVID-19 these past few weeks, including Sarah Jessica Parker, Miley Cyrus, Daniel Craig, and nearly 75 of Washington's elites such as House Speaker Nancy Pelosi and Attorney General Merrick Garland, just to name a few.

Accordingly, interest has grown in a fourth vaccine dose, approved recently by the FDA, for Pfizer and Moderna, for people age 50 or older (as well as a few other groups with weakened immune systems).

With major cities in Europe and China, as well as some parts of the U.S. seeing an uptick in cases driven by the BA.2 subvariant, the CDC quickly backed the FDA's decision, though it's worth noting that both agencies made their decisions without consulting their committees of independent vaccine experts. While this has been done before, this action continues to come under intense scrutiny.

With renewed worries about another wave of coronavirus infections comes three questions employees and employers have on their minds:

1) Are today's at-home tests capable of detecting the Omicron BA.2 subvariant? 

2) Are health plans still required to cover at-home rapid tests?

3) What's the latest guidance on mixing booster shots?

Technology like artificial intelligence, machine learning, and predictive analytics are transforming Human Resources information systems. The change is happening so rapidly that even those who updated their human capital management (HCM) systems as recently as five years ago likely aren’t up-to-speed on the changes.

The pace of change is reflected in the growth of human resources technology: In 2020, the global human resource management market comprised sales of $17.6 billion, with estimated annual growth of 12.2% through 2028.

Many HR managers and executives simply don’t know what’s possible, making it difficult to upgrade even antiquated systems. The future for HCM is bright, but not all HR departments can yet see the possibilities in the new systems.

Our HR Technology Specialty Practice experts are well-versed in helping employers navigate this ever-evolving landscape of HCM technology. Here are a few steps to follow as you begin your journey towards upgrading your HR tech.

When 56% of student loan borrowers say they’d take a punch in the face from heavyweight boxing legend Mike Tyson and 40% would take one year off their life expectancy if it meant they’d be relieved of student debt, it probably means the public is under financial stress.

And that was before the coronavirus pandemic further complicated finances. Financial stress seems to be endemic: Three-quarters of American workers say they feel financial anxiety every day. The causes for this are numerous and varied, from insufficient savings (80%) and retirement funds (73%) to ballooning credit card balances (19%).

Financial anxiety doesn’t exist in a vacuum. There’s a tight link between financial, emotional, and physical health, and when an employee’s financial anxiety becomes overwhelming, it can affect the body and mind.

What’s more, that state of financial distress results in rising rates of presenteeism, absenteeism, and workplace accidents that can result when workers are distracted by financial worries. Consider that 43% of employees spend time working on their personal finances while at work.

As a result, many employers realize that a myopic focus on core benefits like health, dental, and vision shortchanges employees. Finding ways to integrate financial wellness into a holistic wellness strategy will be a competitive advantage, especially as many workers are emerging from the pandemic feeling financially scarred from the experience.